This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. There is a high rate of moderate-severe periodontal disease in pregnant API women compared to mainland USA women. Periodontal infections are associated with preterm birth in both gestational diabetic and non-diabetic pregnant women. Although periodontal infection is associated with gestational diabetes and preterm birth in our population, the relationship between periodontal infection and insulin resistance is unknown. Specific Aim 1: To determine whether maternal periodontal disease is associated with a decrease in the levels of insulin-like growth factor-1 in maternal serum and whether IGF1 suppression is an intermediary variable in the association between maternal periodontal status and glycemic control. Specific Aim 2: To determine whether fetal-placental exposure to maternal oral organisms, as measured by fetal cord blood IgM titers to oral pathogens, is associated with a change in the levels of insulin-like growth factor-2 in maternal serum and/or in fetal cord blood at delivery and whether fetal IgM seropositivity and IGF2 levels are intermediary explanatory variables in the association between the maternal periodontal status, maternal glycemic control and birth weight for gestational age. Specific Aim 3: To establish necessary infrastructure and support to conduct a future longitudinal clinical trial from 16 weeks gestational age until 3 months postpartum. A future trial will last 5 years and enroll 1,400 women. Goals include: 1) Orient community clinics, University of Hawaii faculty private practices, house staff clinics, and private practitioners to the study. 2) Optimize patient recruitment and continuation in the study. 3) Establish biologic sample collection and storage for the following: a) Periodontal plaque and fluid samples at 11-15 weeks, delivery and postpartum, b) maternal blood at 11-15 weeks and 35-38 weeks GA, c) cord blood and placental sample collection, d) glucose tolerance testing. We will be studying Asian and Pacific Island women, as gestational diabetes mellitus (GDM) and type 2 diabetes are significant health problems for this minority ethnic group. Females age 14 and older who are pregnant (11 to 15 weeks gestational age) and whose ethnic background includes Asian or Pacific Islander ancestry, will be enrolled. Exclusion criteria follows: 1) Type 1 or 2 diabetes mellitus, 2) rheumatic heart disease, 3)orthodontia that would prevent periodontal evaluation, 4)excessive gingival overgrowth, 5) subjects less than 14 years of age, 6) incarcerated, 7) language barrier [unreadable]unable to speak or understand English. Patients will be recruited from the University of Hawaii prenatal care clinics. Additionally, private medical and dental practitioners in the community will be notified of the study, and will be able to refer patients from their private offices. Subjects will be seen on 6 different occasions during the study interval: 1) Screening and /enrollment: before visit 1 2) Visit 1: 11-15 weeks gestation 3) Visit 2: 24-28 weeks gestation 4) Visit 3: 35-38 weeks gestation 5) Visit 4: Delivery 6) Visit 5: Postpartum 8-16 weeks Data from this and the subsequent RO1 application will enable us to study the mechanisms underlying gestational diabetes, and potentially enable us to develop interventions to prevent the condition, or optimize maternal and fetal outcomes.